Provider Demographics
NPI:1710293618
Name:ROEDER, HARVEY JAMES III (DC)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:JAMES
Last Name:ROEDER
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:ROEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:5802 S 67TH ST
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-8460
Mailing Address - Country:US
Mailing Address - Phone:479-254-3999
Mailing Address - Fax:479-254-3998
Practice Address - Street 1:1401 SE WALTON BLVD
Practice Address - Street 2:113
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3759
Practice Address - Country:US
Practice Address - Phone:479-254-3999
Practice Address - Fax:479-254-3998
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15720171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARACUPUNCTUREOtherSTATE BOARD OF CHIROPRACTIC EXAMINERS